Provider Demographics
NPI:1871952374
Name:ZIMMER, MELISSA MARIE (LCSW, LCASA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:LCSW, LCASA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCASA
Mailing Address - Street 1:19 LOFTIN ST
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8863
Mailing Address - Country:US
Mailing Address - Phone:910-391-7755
Mailing Address - Fax:
Practice Address - Street 1:19 LOFTIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8863
Practice Address - Country:US
Practice Address - Phone:910-391-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23571101YA0400X
NCC0118171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)